Maybe I’m just getting to be an older and more cynical pharmacist? Maybe I can’t see the merits of certain decisions? Maybe there is value to changing hydrocodone combination products (HCPs) to C2 status? Or maybe, I have a valid concern that this is the wrong way to handle a real problem.
Starting October 6th, 2014 chronic pain patients and pharmacists will notice a significant change that will impact both groups. The decision has been made to change the status of hydrocodone combination products from C3 to C2 status. The move will further restrict legal access to this group of medications and put them on the same level of control as other C2 medications such as oxycodone.
The natural question to ask is will this do any good? Will it make an impact on the abuse problems we now face in the United States? Or worse, will it become a burden for chronic pain sufferers who need access to these medications?
I think the idea needed to be considered. The drug abuse problem in America has gotten that bad. Even bad ideas that might address the problem should be considered. But again, I am referencing “bad ideas” to describe this change. That should clear up how I personally feel on the matter.
I would have looked to see if the idea was already working anywhere in the country already. The problem, only New York previously changed HCPs to C2 status on their own and that just happened last year. If there is any significant data showing it’s impact on the abuse problems of HCPs in New York, I can’t find it. If New York had years of data proving it helps, I might feel differently.
One can only look at the abuse problems a drug like oxycodone has despite it’s C2 status and wonder if drug classification is the root problem. Of course, you can’t exactly determine how much worse things might be for a drug like oxycodone if it were C3 status. But it’s not a good sign to look at the peers in this classification group to validate this decision.
Unless prescribers really start to evaluate their own prescribing habits things will not significantly change. Unless we look at our drug culture that actively promotes “a pill is the answer” mentality for anyone with a problem, things will not change.
And what is worse, the law of unintended consequences suggests that legitimate chronic pain sufferers will be impacted more by this change than anyone else. The last thing we need is to make it more difficult for people who are actually suffering from pain to get relief.
It will be interesting to see what impact this change will have on HCPs in the near future. Will those products be avoided now by prescribers? Will patients ask for alternatives?
I wonder if prescribers will try tramadol or codeine combination products more often now to avoid the new C2 restriction on HCPs? Will prescribers that normally would have considered hydrocodone combination products simply bump some patients up to oxycodone products?
I have seen anecdotal evidence in my area that there has been an uptick of HCP scripts in recent weeks. I wonder if pain patients are “stocking up” before the switch in status? I’d be curious to hear if anyone else has noticed similar trends recently.
I’d like to be on board with this idea. I’d like to say that everything will be fine starting 10/6/14 and that hydrocodone abuse will start a nice gradual decline after it become C2.
But the reality is I can’t help but feel that this will not do what it intended to do. We will continue to have a serious drug abuse problem even after early October. This will not change that fact. And that leaves us with the real question of the day: what can be done that will actually work?
The Redheaded Pharmacist